Healthcare Provider Details

I. General information

NPI: 1376165498
Provider Name (Legal Business Name): WILSON PHARMACY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 COMMERCE STREET
SILVERTON TX
79257
US

IV. Provider business mailing address

PO BOX 685
LOCKNEY TX
79241
US

V. Phone/Fax

Practice location:
  • Phone: 806-823-2109
  • Fax: 806-823-2110
Mailing address:
  • Phone: 806-652-3353
  • Fax: 806-652-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANCE WILSON
Title or Position: OWNER
Credential:
Phone: 806-652-3373